Provider Demographics
NPI:1306664339
Name:MARTIN, RHEAVEN (LMT)
Entity type:Individual
Prefix:
First Name:RHEAVEN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N ROBINSON CIR
Mailing Address - Street 2:APT M2
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1096
Mailing Address - Country:US
Mailing Address - Phone:618-561-0264
Mailing Address - Fax:
Practice Address - Street 1:707 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2125
Practice Address - Country:US
Practice Address - Phone:618-207-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227022765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist